PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MS.ARCHANA SYIEM
I YEAR M.Sc. NURSING
PSYCHIATRIC NURSING
YEAR 2013-2015
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI
BENGALURU-5600072
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / MS. ARCHANA SYIEMPADMASHREE COLLEGE OF NURSING, GURUKRUPA LAYOUT, NAGARBHAVI, BENGALURU- 560072.
2. / NAME OF THE INSTITUTE / Padmashree College of Nursing, Bengaluru.
3. / COURSE OF THE STUDY AND SUBJECT / I Year M.Sc. Nursing (Psychiatric Nursing)
4. / DATE OF ADMISSION TO THE COURSE / 27/05/2013
5. / TITLE OF THE STUDY / A study to assess the effectiveness of training programme on knowledge and attitude regarding geriatric mental health among caretakers of elderly in selected old age homes, Bangalore
6 BRIEF RESUME OF THE INTENDED STUDY:
6.1 INTRODUCTION:
Older men are to be sober-minded, dignified, self-controlled, sound in faith, in love, and in steadfastness.
-Titus 2:2
Aging is an inevitable developmental phenomenon bringing along a number of changes in the physical, psychological, hormonal and the social conditions.
-Neuhaus and Neuhaus, 1982
Birren and Renner (1977) define aging in terms of the biology, referring to “the regular changes that occur in mature genetically representative organisms living under representative environmental conditions as they advance in chronological age.”1
Population aging has become an important developmental issue that requires urgent action. The World Health Organisation (WHO) 1988 states that “Investing in health and promoting it throughout the life span is the only way to ensure that more people will reach old age in good health and capable of contributing to society, intellectually, spiritually and physically.”2
The boundary between senior and old age cannot be defined exactly because it shifts according to context and to society. People can be considered old because of certain changes in their activities or social roles. Examples are people may be considered old when they becomegrandparents or when they begin to do less or different work-retirement. Most countries have accepted the chronological age of 65 years as a definition of 'elderly' or older person.3
Scientific advances and the consequent progress of medicine have made a decisive contribution in recent decades to prolonging the average duration of human life. People who have retired from active employment, yet still have great inner resources and are still able to contribute to the common good. To this huge throng of “young old” (as they are called by the new categories of old age defined by demographers, i.e. those aged between 65 and 70) is added a so-called fourth age, that of the “oldest old” (those over 75), whose ranks are likewise destined to become ever more numerous.4
Psychological problems arise as old age people are not able to respond to stimuli as they could earlier. The psychological problems arise when people realise their loneliness. The problems can be developed from role changes, modernisation, disintegration of joint family system, physical disability, retirement from physical activity, insecurity, social isolation, death of spouse, lack of support from family members, abuse from caregivers, when social life is disrupted, or when they feel a sense of loss. This leads to slow build-up of stress and discomfort. The psychological effects of stress include anxiety, depression, loneliness, low self-esteem, and feeling of powerlessness.5
The process of aging also tends to create psychological and social problems for the individual and the society. The degree of adaptation to fact of aging is crucial to one’s happiness. Failure to adapt can result in depression, anxiety and agitate behavior and other related psychological problems.6
Elders are like children with their mood swings, sometimes too quickly not allowing us enough time to grasp. Elders need attention at homes and if we don’t give it, they start demanding it. When the elders begin to feel they are neglected, they adopt ways to attract attention from us and at times irritating. Mental agitation, restlessness, falling sick often, nausea, vomiting and even suicide attempts could be just reactions to this neglect by family members. Older people are in need of vital support that will keep important aspects of their life-styles intact while identity and in turn it leads to low morale, decreased level of satisfaction, depression and feeling of loneliness and helplessness. Thus the problems associated with aging are numerous. Broadly speaking the main problem of the aged in our country is related to socio psychological economic and health problems.7
Old age homes are a need of today as the life-styles are changing fast and diminishing acceptance of family responsibilities towards one’s elders. Older people are, therefore, in need of vital support that will keep important aspects of their life-styles intact while improving their overall quality of life (Kivelt and Scott, 1979).The above studies demand that we should understand the concept of old age homes thoroughly and evaluate psycho-social status of senior citizen and related factors.8
6.2 NEED FOR THE STUDY:
According to W.H.O: Currently about two-third of all older persons are living in the developing world; by 2052 that will rise to 75%.Its report of 2004 state that, 536 elderly people per 10,000 suffer from physical and psychosocial problems of old age.
The changing demographic scenario and population projections of India indicate that the growth rate of Indian older adults (aged 60 years and above) is comparatively faster than other regions of the World. Since recent past, due to marked increase in life expectancy, rise in number and proportion of older adults, the population of older adults is increasing at a fast pace.
In India at present, older adults constitutes 7.6% of total population. Within three decades, the number of older adults has more than doubled i.e. from 43 million in 1981 to 92 million in 2011 and is expected to triple in the next four decades i.e., 316 million. This clearly reveals that the growth rate of Indian older adults is comparatively faster than in other regions of the World.
The life expectancy at birth has also increased from 62.5 years in 2000 to 66.8 years in 2011.Rapid growth in percentage and proportion of older adults in the country is associated with major consequences and implications in all areas of day-to-day human life and it will continue to be so. As a result, the aged are likely to suffer with problems related to health and health care, family composition, living arrangements, housing, and migration.9
In Karnataka, out of a population of 5.5 crores, 8% is elderly citizens. The 1st of October every year is celebrated as “World elder’s day” globally.10
According to WHO, it is projected that India by the year 2025, 4 million Indians will become victims of dementia. The theme of this age period is loss, and dealing with death is one of the tasks of the elderly. Science death is the only certainly in life, without emotional support to sustain and bear the losses.[Loss of work role spouse, friends, sensory and motor abilities and intellectual processes] the elderly individuals is vulnerable to depression and despair.11
An epidemiological studies and community surveys on the elderly in India indicate a varied prevalence rate of mental illness or psychiatric morbidity ranging from 2.2 percent to 3.7 percent. Most of these surveys were conducted in Gero-psychiatric clinics; mental health centre located in South India Towers, Calcutta and Agra and also covered the older people from villages and slum areas.12
Traditionally, the family has been the primary source of care and material support for the older adults throughout Asia, and the Indian family system is often held at high position for its qualities like support, strength, duty, love, and care of the elderly. The responsibility of the children for their parent’ swell lbeing is not only recognized morally and socially in the country, but it is a part of the legal code in many states in India. But urbanization, modernization, industrialization, and globalization have brought major transformations in the family in the form of structural and functional changes. As a result of these socio-demographic changes, older adults at times are forced to shift from their own place to some institutions/old age homes.
To correct the current, largely negative image of old age is therefore a cultural and educational task which ought to involve all generations. We have a responsibility towards older people today, we need to help them to grasp the sense of their age, to appreciate its resources, and to overcome the temptation to reject it, and so succumb to self-isolation, resignation and a feeling of uselessness and despair. We also have a responsibility towards future generations: that of preparing a human, social and spiritual context in which each person may live this period of life with dignity and fullness.13
Dhillon (1992) stated that sudden retirement does have an adverse impact on healthy persons who have seen working for generations as it results in loss of role, status, power, opportunities for interactions and loss of an occupational identity and in turn it leads to low morale, decreased level of satisfaction, depression and feeling of loneliness and helplessness. Thus the problems associated with aging are numerous. Old age homes are a need of today as the life-styles are changing fast and diminishing acceptance of family responsibilities towards one’s elders.14
This segment of population is more vulnerable to health-related problems including mental health problems. Various prevalence studies have reported mental health problems among older adults to be very higher than other age groups.The available literature indicates that there are hardly any effort to understand the morbidity and the needs of such elderly people and specific studies related to the issue are hardly available. Viewing it, to assess mental health and other associated morbidities among inhabitants of old age homes, a study was planned and carried out .15
The elderly citizens are in need of urgent attention. They do not need our pity but the understanding love and care of their fellow human beings. It is our duty to see that they do not spend the twilight years of their life in isolation, penury and misery. Older people are, therefore, in need of vital support that will keep important aspects of their life-styles intact while improving their overall quality of life (Kivelt and Scott, 1979).16
At present, besides government run old age homes, several voluntary organizations for social welfare and also the religious groups are running these homes. Private organizations have also established old age homes which have well-made schedules which cater to the needs of elderly, provide them with treatment and look after them in caring and methodical way. With the family increasingly nuclearized and with the progressive lengthening of the average life span, it becomes necessary that special steps be taken for the welfare of retired and needy aged people. Therefore it demands that we should understand the concept of old age homes thoroughly and evaluate psycho-social status of senior citizen and related factors.17
Taking into consideration all the above facts, the researcher felt to develop a training programme on caretakers of elderly in old age homes and to suggest the steps to be taken in order to prevent and minimize some of the adverse behavioral disorders among the elderly.
6.3 STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of training programme on knowledge and attitude regarding geriatric mental health among caretakers of elderly in selected old age homes in Bangalore.
6.4 OBJECTIVES OF THE STUDY:
1. To assess the pre test level of knowledge and attitude regarding geriatric mental health among caretakers of elderly.
2. To administer the training programme regarding geriatric mental health among caretakers of elderly.
3. To assess the post test level of knowledge and attitude regarding geriatric mental health among caretakers of elderly.
4. To compare pre test and post test level of knowledge and attitude regarding geriatric mental health among caretakers of elderly.
5. To correlate level of knowledge with attitude regarding geriatric mental health among caretakers of elderly.
6. To associate the pre test level of knowledge and attitude regarding geriatric mental health among caretakers of elderly with their demographic variables.
6.5 OPERATIONAL DEFINITIONS:
1. Effectiveness: It refers to the improvement in the level of knowledge and attitude regarding geriatric mental health among caretakers of elderly after the training programme.
2. Geriatric Mental Health:It refers to a state of well-being in which elderly people realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
3. Training Programme:It refers to the training based on the module developed by the investigator. The training module contains education regarding geriatric mental health, role of caretakers in management of geriatric mental health problems and care for old age related to geriatric mental health.
4. Knowledge:It refers to the response of the caretakers of elderly regarding information on geriatric mental health which will be assessed using structured knowledge questionnaire.
5. Attitude:It refers to the opinion of the caretakers regarding geriatric mental health which will be assessed using 3 point rating scale.
6. Care takers of elderly: The individual’s appointed as a staff in the old age homes to take care of the elderly.
7. Old age homes: The institution which caters care and service for the elderly.
6.6 ASSUMPTIONS:
1. Elderly may experience some sort of psychological problems.
2. Training programme on geriatric mental health may enhance the knowledge and
attitude among caretakers of elderly.
3. The level of knowledge and attitude on geriatric mental health caretakers of
elderly may vary with demographic variables.
6.7 HYPOTHESES:
H1 : There will be significant difference in the pre-test and post-test level of knowledge and
attitude regarding geriatric mental health among caretakers of elderly.
H2 : There will be significant co-relation between the level of knowledge and attitude regarding
geriatric mental health among caretakers of elderly.
H3 : There will be significant association between the level of pre-test knowledge and attitude